The Shaman of the Emergency Room
"...Hey, Hyun-jae." A cautious voice came from behind me. It was Lee Min-jae.
"Yes, Senior."
"How did you know?"
"Ah... well... that is..." My mind went blank for a second. What was I supposed to say? 'A ghost living in my head told me'?
"Tell me. It's fine. I'm just curious."
"Well, you see... at first, I was considering other possibilities too. But then..." I paused, pretending to recall the situation. "I tried to connect the dietary history of spinach and carrots mentioned by the guardian with the child's obvious cyanosis. Then, looking at the oxygen saturation level, it suddenly clicked."
"Hmm. Because it was 85%?" Lee Min-jae asked.
Exactly.
"Yes. That number was too strange. A pulse oximeter should normally show a value very close to the actual arterial oxygen saturation. But in methemoglobinemia, regardless of what the actual saturation is, the device tends to get locked and display a value right around 85%."
"Aha, right. The limitation of the pulse oximeter. But still, isn't this incredibly rare? I've only read about it in textbooks; today is the first time I've ever seen it in person."
"Yes, that's my understanding as well. I believe fewer than five cases are reported annually in pediatric patients nationwide. Most occur in infants who have eaten baby food or consumed contaminated water."
Of course, it was a complete lie. There was no way I actually knew that. I just knew it was rare, so I made up a plausible-sounding number. But my incredibly specific answer completely swept away the last shadow of doubt in Lee Min-jae's eyes.
"...You even knew that?"
Yep, hook, line, and sinker. When you pretend to know something this flawlessly, nobody doubts you. They just assume you're a genius and a hardcore study bug who stays up all night digging through medical journals and memorizing the prevalence rates of every rare disease.
Lee Min-jae stood up.
"...I knew it. The ER is the place for you."
"Haha, is that so?" I scratched the back of my head with an awkward laugh. Huh, he's not making a fuss today.
"Hey."
"...Yes?"
"You..." Lee Min-jae suddenly grabbed both of my shoulders. Then, he began to shake me like crazy. "You magnificent bastard!!! You are the real deal!! The absolute real deal!!!"
The theatrics had finally begun.
"While I! Was barking up the wrong tree! You! You were already looking at the truth beyond!!"
Lee Min-jae showered me with praise in a booming voice and exaggerated gestures. The nurses and interns glanced over at us with expressions that clearly said, There he goes again.
"Uh... yes, yes..." My brain was starting to rattle from his passionate shaking.
"You're not just a genius! You are... a medium! A shaman of the ER who sees the soul of the disease within the symptoms of a dying patient—something we mere mortals can never perceive!"
What kind of nonsense is 'shaman'? Well, I guess it's not technically wrong, but... Please, someone come and take this guy away.
"Anyway, great job, our ER shaman. I shall go attend to other patients now."
Left alone in the empty Resuscitation Room, I chewed on Lee Min-jae's parting words. Shaman... This was exactly why I hated working shifts that overlapped with his. Of course, Lee Min-jae was a highly competent doctor. As a fourth-year resident. As the chief resident. His clinical judgment and procedural skills were unquestionable. His problem lay elsewhere. He was just too passionate.
I stared blankly into space as I recalled next month's duty roster. Please. Please keep me as far away from that man as possible.
And so, countless patients passed through my hands.
"Doctor, my child swallowed a coin!" An X-ray revealed a 100-won coin sitting perfectly round right in the middle of the esophagus. I explained that it had to be removed via endoscopy.
"His head is split open!" A five-year-old who had tumbled down. I put on an animated video for the child, administered local anesthesia, and gave him three stitches.
"The fever... the fever is spiking again!" A child whose temperature wouldn't drop below 38.5°C (101.3°F) even after taking antipyretics. I ran a flu test, started an IV, and ordered a urinalysis to rule out a potential urinary tract infection.
Drowning in the chaotic sea of children's cries and parents' heavy sighs, I looked up to find the clock hands already pointing toward 3:00 AM.
"Dr. Han!" a nurse at the station called out urgently.
"A fifteen-month-old baby boy tripped over a threshold while riding his baby walker and fell. They say he hasn't been able to put any weight on his left leg since, and he won't stop crying..."
"Oh, got it. I'll be right there." I set down my instant mix coffee and hurried over to Bed C-7.
A baby walker fall. One of the most common mechanisms of pediatric orthopedic trauma. However, the phrase "unable to bear weight" always set my nerves on edge.
On the bed, a tiny baby boy was crying hysterically, his face flushed bright red. I reassured the parents first before approaching the child.
"Let the doctor take a look, okay? You're going to be fine." Soothing the child in my gentlest voice, I carefully examined his left leg. Externally, there was absolutely nothing wrong. No swelling, no bruising, and no deformity like a twisted limb that would suggest a broken bone. It looked like a perfectly normal baby's leg.
Very gently, I began to palpate with my fingers. Thigh—fine. Knee—fine. Ankle—fine. And then, the shinbone. The moment my finger lightly pressed against the tibia—
"Waaahhhhh!" The baby shrieked.
Found it. The classic tenderness that appears when there's a hairline fracture in a bone that looks perfectly fine on the outside. A toddler's fracture. It occurs when young children with weak bones fall or twist their feet, causing a tiny spiral fracture in the tibia.
I explained to the parents that we needed an X-ray. Then I returned to the station to report to Lee Min-jae.
"Senior, I suspect a toddler's fracture in the patient in C-7, so I ordered a tibia/fibula AP and lateral view."
Lee Min-jae, who was reviewing the chart of another mild patient, tilted his head.
"An X-ray? You said there's no swelling. Can't we just apply a posterior splint and give him some pain meds? Is it really necessary?"
Exposing a seemingly fine child to radiation for an X-ray could easily look like over-treatment. But I was confident in my diagnosis.
"The tenderness is too localized and distinct. I don't think it's just a simple sprain."
"Of course! Our genius always sees things differently! Yes! The eyes that see the unseen! The mind's eye that peers into the microscopic cracks of the bone! Excellent! Go forth and shoot!" Lee Min-jae fell into his own world again, marveling and convincing himself. Well, works for me.
It would take about fifteen minutes for the results. I sank into a chair and closed my aching eyes. Yaaawn. A massive yawn escaped my mouth.
Come to think of it, I used to break my bones all the time when I was a kid.
During elementary school, I was practically a VVIP at the local orthopedic clinic. I broke my arm jumping off a wall, fractured my ankle playing soccer, and cracked my collarbone falling off my bicycle. Walking around with a white plaster cast wrapped around my limbs was the trademark of my childhood. I remembered giggling at the doodles my friends left on the plaster, and the pungent, musty smell of the cast. Back then, I didn't realize that my parents' hearts must have ached far more than my broken bones as they rushed me to the hospital.
Perhaps becoming a doctor is a process of learning the weight of others' suffering by overlaying it with your own past.
As I was lost in thought, a notification popped up on the EMR screen. It was the signal that the X-ray was complete. Lee Min-jae and I moved to the station monitor at the same time. The image of the fifteen-month-old baby's tiny, white tibia appeared on the screen.
"Let's see..." Lee Min-jae clicked the mouse to zoom in on the image. He meticulously scanned the outline of the bone from top to bottom, then let out a hollow laugh.
"Hyun-jae, look at this." He gestured toward the monitor with his chin. "It's perfectly clean, not a single fracture line. The ligament was probably just a bit shocked. What did I tell you? Even geniuses make mistakes sometimes! Haha!"
He was right. Anyone looking at the monitor could see the bone was pristine. Ah, it's not broken. Thank goodness... I let out a sigh of relief. The relief that the child wasn't seriously hurt far outweighed the embarrassment of my diagnosis being wrong. I had made a fuss and put the kid and parents through unnecessary trouble, but having nothing wrong was a hundred times better.
I was about to turn around to explain to the parents that the bone was fine and we should just apply a splint and monitor it for a few days. But just as I was about to move—
...Wait a minute.
I grabbed the mouse and zoomed in to the absolute maximum. Then, I began adjusting the brightness and contrast of the screen. The screen darkened, then brightened to a stark white. The outline of the bone blurred, then sharpened again.
The very edge of the tibia, just below the kneecap. The faint area near the growth plate where cartilage meets bone in children whose growth is not yet complete. There, I saw a faint line, too ambiguous to confidently call a fracture line.
What is this? A shadow? Or just a normal shading seen during the growth process? I tilted my head and zoomed in on that area once more. But the more I looked, the more confusing it became. I was tempted to just let it go, but a nagging feeling in the back of my mind held me back. In the end, I turned to my last resort.
The first person to respond to my question was not a bone enthusiast, but an unexpected figure.
The moment I saw that comment, a cold shiver ran down my spine. A sudden, intense sense of dread washed over me. What was it? A rare bone disease? A new kind of infectious disease? Was that why I needed to report it to the health authorities?
With trembling hands, I typed a reply.
...The police?